Muslim Pilgrimages Could Lead To Global Spread Of MERS Coronavirus

Two upcoming mass gatherings involving millions of individuals could cause Middle East respiratory syndrome-coronavirus (MERS-CoV) to spread internationally, according to new research published in the online journal PLOS Currents: Outbreaks.

Lead investigator Dr. Kamran Khan of St. Michael’s Hospital and his colleagues warn that MERS could spread faster and wider during the upcoming umrah and hajj, which typically draw millions of foreign and domestic Muslims to Saudi Arabia, the Toronto-based medical facility explained in a statement.

The umrah is a pilgrimage often performed by Muslims during Ramadan, which runs from July 9 through August 7, while the hajj is a five-day long pilgrimage that takes place and is required of all physically and financially-able Muslims at least once during their lifetimes. It takes place from October 13 through October 18 this year.

Dr. Kahn’s team studied global airline traffic from 2012 and historic hajj data in order to predict population movements in and out of Saudi Arabia and the entire Middle East region during both of these mass gatherings. The goal was to help different nations assess the possibility that MERS could be introduced within their borders by individuals returning from one or both pilgrimages.

He also looked at economic and per capital health care expenditure based on information obtained from the World Bank in order to gauge each country’s ability to detect and respond to a potential MERS outbreak in a timely fashion.

The researchers found that out of 16.8 million travelers who boarded commercial flights departing from Saudi Arabia, Jordan, Qatar and the United Arab Emirates (the four nations that MERS has been linked back to) between June and November 2012 (the period starting one month before Ramadan and ending one month after the hajj), more than half (51.6 percent) were scheduled to land in just eight different countries: India, Egypt, Pakistan, Britain, Kuwait, Bangladesh, Iran and Bahrain.

Over sixteen percent of all travelers had India as their destination, while 10.4 were headed for Egypt and 7.8 percent were en route to Pakistan. Furthermore, Dr. Kahn and his colleagues found that there were 12 cities – Cairo, Kuwait City, London, Bahrain, Beirut, Mumbai, Dhaka, Karachi, Manila, Kozhikode (India), Istanbul and Jakarta – each received over 350,000 commercial air travelers.

“In contrast to SARS, where the disease was introduced into predominantly high-income countries through air travel, more than half of all air travelers departing Saudi Arabia, Jordan, Qatar and UAE have final destinations in low or lower-middle income countries,” officials from the hospital said in a statement. “Two-thirds of all hajj pilgrims originate from low or lower-middle income countries.”

“Of particular note is the degree of connectivity between the Middle East and South Asia,” they added. “Collectively, India, Pakistan, Bangladesh, Afghanistan and Nepal represent the final destinations of nearly one-third of all international air travelers departing Saudi Arabia, Jordan, Qatar and the UAE, and the origins of roughly one in four foreign hajj pilgrims worldwide.”

Dr. Kahn said that given the limited economic resources of the nations in question, they could have difficulty identifying new MERS cases and implementing treatment programs should the coronavirus reach their shores. He suggests implementing screening individuals as they leave source regions in the Middle East instead of when they arrive at their international destination imports.

The researchers also advise all countries receiving pilgrims and other travelers from known MERS regions to mobilize their infectious disease surveillance and public health resources in proportion with their potential to introduce the illness to their destination country.

They also emphasize the importance of educating and preparing front-line health-care providers to recognize potential coronavirus infection and implement proper control practices in order to minimize the risk that the illness will be spread to other people.

Earlier this week, health officials in Saudi Arabia announced that they would deny visas to some groups of travelers seeking to visit Mecca as part of the hajj this October.

The country stated that they would block elderly pilgrims or those with pre-existing chronic conditions from entering the country in order to help protect them against the coronavirus. Furthermore, Saudi health officials are requesting those who do attend to wear masks in order to help prevent the potential spread of this virus.

The potential for a global MERS pandemic also led to World Health Organization (WHO) officials to meet with officials from the Kingdom of Saudi Arabia (KSA) earlier this month.

To date, there have been 55 confirmed cases of the disease, which is related to the SARS strain that killed over 700 people back in 2003. However, in a study published earlier this month, scientists from the Institut Pasteur in Paris said that they believe that the new coronavirus is a less transmissible disease than its predecessor.

On Thursday, the WHO announced that they had been notified of six additional laboratory-confirmed cases of MERS infection, two of which were from Saudi Arabia the other four which were from the United Arab Emirates (UAE). That raised the number of laboratory-confirmed infections to 88, including 45 deaths.

Both cases from Saudi Arabia reportedly had mild symptoms and were not hospitalized, while the four UAE cases were all health care workers at two different hospitals in Abu Dhabi. Two of them did not develop symptoms of illness, while the other two had mild upper respiratory symptoms and were reportedly in stable condition.